The final shot of season five left me with a lump in my throat as Dr. Gregory House disappears into Mayfield Psychiatric Hospital. It’s a bleak finish to a mostly downbeat season. And it's the final shot of a season that should (if there is any justice in the Emmy world) win Hugh Laurie his long-deserved Best Dramatic Actor award. (But more about that in my next article.)

Although there were a few wrong steps here and there, I believe season five is probably the most cohesive of the entire series. (Of course, your mileage may vary.)

With no artificially inserted House-nemesis (ala Vogler—season one, and Tritter—season three), no survivor games, and a storyline threading a direct line from season four’s finale right through the final episode of this season, House, M.D. gave us a strong season with a compelling story.

House has dwelled upon a precipice since we first meet him in the first season. An essentially unstable character, teeter-tottering on the edge, House has danced with self-destruction that has occasionally bordered on suicidal. In an interview with Elvis Mitchell in the early days of season two, Hugh Laurie acknowledged this, wondering how long it would be before the audience finally cried: “For heaven’s sake, just jump already!”

This season, House seemed to edge ever and ever closer to emotional collapse. Unlike Kutner's abrupt and shocking exit, which no one foresaw, House's demise had many clues; many cues. Loss piled upon loss until, finally, he simply snapped, crushed under the weight of too much, punctuated by the loss of the only thing he could rely upon: belief in himself.

Should his colleagues have seen it coming? Were there neon signs and marquees pointing to House's inevitable crash? Looking back on season five, I would say yes. And no. Yes, they might have seen it coming from miles off, but House's own personality, in denial nearly until the end, would have prevented anyone from really helping him.

And what were those clues? I began to re-examine the season, episode by episode, looking for the the signposts to House's demise. And here they are, presented as a starting point for what I hope will be a summer of debate about where the show (and House) will go from here:

1. The "white bus scene" at the end of season four and House's guilt over Amber. Picking up only a few weeks from where season four's story left viewers, season five explores the three things that House expresses to Amber in the crucial "white bus" scene in "Wilson's Heart." "I don't want to be in pain; I don’t want to be miserable; I don't want him (Wilson) to hate me." So much of season five addresses these three confessions: his relationship with Wilson, his misery and his physical pain.

The events of the season four finale leave House vulnerable and emotionally fragile. He is not in a great place even as the season begins. His feelings of guilt over Amber and his strong denial of them in "Dying Changes Everything," the season five premiere sets House up for another crash, perhaps less physically violent, but no less jarring than the bus crash that ended season four.

2. Wilson's exit from House's life. House's worst fears about Wilson are realized at the end of "Dying Changes Everything," when Wilson decides that House is simply too toxic. And he wants to end their association. “We’re no longer friends, House. I don’t think we ever were,” he cruelly says to the bereft House. Wilson's departure leaves House isolated and bewildered—and it is the first of many blows to House's psyche during season five.

By episode two, "Not Cancer," House is pining for his friend, coping badly with his new reality. Even the eventually annoying private investigator Lucas feels bad for House, who is hurt by the knowledge that Wilson has remained friends with everyone else, while trying to completely trying to shut him out. The moment House throws money into Wilson’s apartment, and then practically pleads with him to just talk, I began to wonder how long House would hang to his sanity if Wilson really left for good.

3. The death of House's father in "Birthmarks." John House's death causes House to revisit his past, even as it brings Wilson back into his life. Claiming that he simply doesn't care masks deeper feelings, which emerge in conversations with Wilson and in House's bitter eulogy. But the bigger blow comes when House realizes that although John House is not his biological father, he is who made him (for better or worse) into the man he has become. House gains no comfort from confirming that John was not his father. It doesn't take away the pain of his childhood, or give him any solace.

4. Cuddy's adoption plans and House's feelings for her. Just as Wilson returns, Cuddy hits House with the news that she's going to adopt a baby in "Lucky 13." House's shell-shocked expression as Cuddy excitedly tells him the news, reveals how upset House really is about this turn of events. Both Wilson and Cuddy are bewildered at House's strange reaction. No snark, no mockery only "If you're happy I'm …" He's clearly caught with a lump in his throat and his quick move to put the sunglasses back is clearly meant to conceal his feelings.

As Wilson tells House in the next episode "Joy," Cuddy has moved on to high school while he's stuck in eighth grade. Resentful of the potential intrusion into his life, and Cuddy's intention to move on to a new phase in her life, House really does begin to feel "stuck" and unable to get himself out of the hole he's made for himself over the years. And as everyone around him seems to move on with their lives (sometimes even with his counsel and help—Cuddy, Foreman, 13, Chase, and Cameron all benefit from House's wiser instincts during season five), he cannot seem to move. I think this bit of self-knowledge weighs heavily on House for much of the last half of the season.

5. House's misery and the fear to change. I believe the impulsive, passionate kiss at the end of "Joy" awakens House to the depth of his feelings for Cuddy. But more important than that, it arouses an impulse to change his story: to make his life less about the misery and pain; to get on with life. To act on what has bugged his subconscious since the "white bus" conversation.

This realization hits home at the end of in the next episode, "The Itch." House lectures his agoraphobic patient about his fear to change. Telling him that he's only rationalizing House says, "Yeah, you're agoraphobic, yeah, you got PTSD, but you're also a coward. If you want to change your life, do something. Don't believe your own rationalizations that you want to lock yourself up and pretend you're happy." For once paying attention to his own words, the truths he utters seem to resonate rather than deflect. But while the agoraphobe takes his first steps outside to lay flowers at his girlfriend's grave, House is unable to muster the self-confidence knock on Cuddy's door. He tries, yet fails, as he will do several times more during the months to follow.

In “Emancipation,” House's conversation with his patient, an emancipated minor, also resonates deeply. (I had so missed those one-on-one conversations in season four, and so happy to see them return in five.)

As House tries to understand what the patient did to alienate herself from her parents, he empathizes with her situation, describing himself, while projecting his own story onto hers. "You're scared and stubborn and you don't want people feeling sorry for you," House begins.

"I don't want people to pity me; I just want to be normal," she answers, echoing a familiar House refrain. "You need people to see how independent you are. How well you're coping. So they won't see the lost, hurt little girl inside." House exposes her, a reflection of his own darkest secrets. Something he steadfastly refuses to let other people see in him. No one is allowed to see House vulnerable, hurting, unable to cope with all his physical and emotional burdens.

In "Last Resort" House, 13 and several patients are taken hostage by Jason, a man whose pathological need for answers mirrors and amplifies House's own relentless "need to know." But by the end of the episode, however, House's own need for the answer to the patient's "puzzle" causes him to needlessly risk not only his own life, but 13's as well. When he is forced to leave 13 alone in the room with Jason, the impact of what he has done finally registers as he stands shell-shocked outside the MRI room. Has House gone a step too far for "the answer?" What if 13 had died? Is this more guilt to be buried deep within House's already-burdened soul?

6. A perfect storm. I believe that House's slow descent into madness really begins in "Painless," the exact midpoint of the season. House's chronic physical pain and his ever-increasing internalized anguish really begin to take their toll.

Some of that internal turmoil comes out in a rare public admission. House speaks with his suicidal pain patient in while in Chase's presence, admitting to someone who actually understands, that the pain is worsening. When the patient warns him that he'd better hope never to see a day when the pills stop working, House's eyes reflect visions of his own bleak future laid starkly before him. And while he ultimately is able to heal the patient and watch him get on with his life, House's reality remains unchanged, feeling ever more trapped within a cycle of pain and misery.

House is even unable to bring himself to participate in the "simchat bat" Cuddy hosts for her new baby Rachel. Telling her that she's a hypocrite for even having the ceremony to enter Rachel formally into the Jewish faith, House is really setting himself up not to go. He believes Cuddy doesn't want him there, and she actually tells him so. Validating his belief he thanks her for being a grownup and being honest: that she doesn't want to bring his misery into a joyous event.

Ultimately, it's actually not what Cuddy wants, but she never gets around to being honest with him. (OK, they're both screwed up.) And in the end House sits at his piano, alone, playing an ode to Cuddy and her baby, a gorgeous, joyful and melancholy medley that only he can hear, pouring out his emotions through the only language he can. He wants to be there; he's thinking about her—and Rachel, but he's simply unable to do anything about it.

And for the first of three separate times this season, House's unshakable atheism is challenged, this time by a cynical priest, whose own faith has been shattered. When, after House diagnoses the priest only by dismissing the one symptom with which he originally presents, the priest suggests a divine hand in sending him into House's care. House is left to ponder the words of science's most rational thinker, Albert Einstein. "Miracles are God's way of remaining anonymous," quotes the priest, who views House as an agent of God—a God in which House cannot believe.

I don't think it's coincidence that in the very next episode, “The Softer Side,” House attempts to deal with his pain and his mood. He is “trying” to change—to do something, finally. And he is hurt when the two people most important to him smack him down for it. Of course, he freaks them both out, because (in true House-like fashion) he hasn't told them he's trying methadone, at best, a dangerous alternative for pain relief.

House is upset when he realizes Wilson thinks he's on heroin, once again thinking the worst of him. And when Cuddy offers him an ultimatum to either give up the methadone (which has eliminated his pain) or his job, he chooses the methadone. "You're choosing the drugs over your job?" she asks in disbelief, not understanding him at all. "No," he explains, clarifying. "I'm choosing 'no pain' over the job." House is clearly disappointed that his friends continue not to understand him.

But eventually they come round, seeing the positive changes in House: he's shaved and put on a suit and tie. He's ready to rejoin society. But a misstep in treating his patient while under the effects of the methadone has given House second thoughts about using the drug. Believing the methadone has affected his ability to reason, something he values even more than being pain-free, he realizes being pain free isn't worth the loss of his intellectual gift. Telling Cuddy that "this is the only 'me' you get," House limps from his office, back to square one with both his pain and his struggle against misery.

The extent to which this is all weighing on House is expressed verbally in "The Social Contract." The patient, someone who has lost all of his social filters and has become an exaggerated version of House, mourns what it has cost him. Asking House to perform a dangerous operation that could bring his life back to normal, he explains: “I could get better or die, I’m OK with that.” House understands better than most doctors could, the gamble his patient is willing to take. He has been there himself.

House pleads the case to Chase, who is unwilling to get involved in the very risky procedure—unless House can explain why he cares so much when there's no medical reason to do it. House reluctantly explains the man's quality of life issues: "When he goes home, he’ll drive his friends away, he workmates away, he’ll alienate his family. And if he's lucky enough, he can find a friend who’ll put up with his crap..until he leaves too.” Chase understands how much of an admission this is, and House's haunted expression as he essentially bares his own soul, seem to stun Chase for its rawness.

House is clearly tired of himself, and the effect he has on people. He hates himself for it and if he can help someone avoid having the sort of life to which he’s condemned, he will.

Also noteworthy in "The Social Contract" is House's genuine attempt to be a supportive friend to Wilson. To be there for him as he confronts his long lost brother, Danny. House's gentle (for him anyway) honesty with Wilson is meant to be the support to Wilson in a way he could not with Amber. It's a subtle change we're meant to perceive in House, as he continues his attempts to change his life. Baby steps, almost unnoticed by his colleagues.

But it is noticed. And in "Here's Kitty," House becomes obsessed with a cat that seems to predict impending death. Wanting to prove that the entire notion is folly, Wilson thinks House's obsession with the cat is indicative of either his own doubts – or that he's beginning to care what other people think, which is another way of caring. And Wilson views that as a good thing, of course.

And once again, the patient wonders about the series of seeming coincidences that has led House to his diagnosis. Is this an "everyday" miracle? Like the priest in "Unfaithful," the cat lady challenges House's worldview that there is no God. Who's to say why the cat jumped onto his laptop right at that moment? Was there some sort of spark of the divine involved? Of course, House would deny it, but it has given him pause.

7. Desperation. So what has led House to see a psychiatrist in "Locked In?" His default position is to see no value in therapy, something we've known since season one. But yet, here he is. We are not told how long he has been seeing a therapist, and I wonder how long he's been trying it. Had he not gotten into the crash, Wilson and Cuddy would never have known.

So what drove him to the shrink? Is House beginning to doubt himself? His worldview? His attitude? Does he think he's losing his mind? His skill? His gift? Is it that House is desperate to try anything at this point to help him change? Is he already having visual hallucinations? Is there something scaring him with regard to his Vicodin use that's causing him to try other things—anything? Is he wondering why he has to negate everything, deflect everything and refuse to deal with himself? Maybe, all of the above.

8. The final straw. By the time of Kutner's suicide, House is already questioning something in his life—enough to seek out professional help (something that must make him both vulnerable and suggests he's already desperate). House never saw it coming, Kutner's death—and it's eating away at him.

But why is it eating away at him? Is it just the puzzle of it, as Wilson ultimately suggests (after thinking there is something more to it)? He is angry at House for not really caring about Kutner, yet he reads House incorrectly. House does care, and is clearly hanging on by a thread. (One only need look into House's haunted eyes to see how deeply he's been affected by the suicide.) He moves around almost as if in a dream state from the time he learns of the suicide, withdrawn and shell-shocked.

House acknowledges, yet doesn't deny, Cuddy's feeling that the work (on the present case) is all that's holding him together. And her belief that without the work to distract him, he will fall apart. She knows he has taken the death much harder than he's willing to let on. The man who saves everyone can't save his own employee. Never saw it coming.

I think Taub nails it when he says (about the patient, but really he could easily be saying it about House), "You can't feel that much guilt without love (read 'caring')." House feels guilty that he saw nothing and could not save Kutner. It is the second death in the course of a year he could not prevent.

House's almost spooky behavior is jarring: from his meeting Kutner's parents through his desperate and pathetic attempt to view the suicide as a homicide to his spending time at Kutner's apartment, going through his photographs. And the episode's final scene shows us a wraith-like House, seeking an explanation of the unexplainable as he silently says good-bye to Kutner, who in many ways resembled his mentor and boss.

Not being able to find meaning in Kutner's death continues to plague House as his confidence flags in "Saviors." Wilson tries to make it better and help House find the path back to his "normal" through a playful mind game. And it seems to help House find his way back after days of self-doubt. However, by the end of the episode we, and House, know that something is terribly, terribly wrong as House's mind conjures a vision of the dead Amber, whose sole intention is to taunt and terrorize him.

9. The inevitable crash. The three episodes that follow, and conclude season five, are an exquisitely wrought filigree of a tragedy in the making. A perfect storm of loss and self-doubt in a man who cannot express the deepest emotions he feels. Confessing that he hadn't slept a full night since Kutner's death stuns House's colleagues more for the fact he's actually revealed it than anything else. Still wracked by guilt over Amber, House becomes burdened by events for which he should feel no guilt: Chase's strawberry allergy in "House Divided," his patient's rare reaction to an antibiotic in "Under My Skin," even Kutner's suicide. And over the final two episodes, "Under My Skin" and "Both Sides Now," House's troubled subconscious paints for him an alternate reality. One that eventually shatters when confronted with the harsh glare of reality in "Both Sides Now."

I believe that towards the end of "Under My Skin," House determines that neither rehab nor electroshock therapy are going to help him. And when he goes to Cuddy's office, he intends to quit—not to ask for her help. He's ready to pack it in. It's like his hallucination tells him: if it's schizophrenia, he's done; if it's drugs, he's done. Over. That he observes Amber telling him this as she slits her arm wrist to elbow, blood pouring everywhere, suggests that House sees either answer as a sort of death.

Lashing out at Cuddy for failing to see his anguish causes her to abandon him mid-crisis. So when he returns home, he has just resigned with nowhere left to turn. He is at as low a point as he has ever been since we first meet him five years earlier. We see only quick flashes of what really happens in his apartment. He takes off his jacket. He's sitting on the bathroom floor near the toilet; he takes a Vicodin and hurls the bottle across the room (maybe intentionally making it difficult to reach).

We also see what his mind has conjured, and perhaps some of that is also real. Maybe he does try to detox on his own and the shivering and nausea we observe really happens. But then maybe he finds one of his Vicodin bottles and takes a pill as he sits on the bathroom floor. It halts the nausea and ends House's withdrawal symptoms.

But his mind has created an alternative reality, a nicer story; one in which he has successfully detoxed (in record time) and is recovering; that he had the help of a supportive friend as he tried to go cold-turkey at home. Someone who knows and loves him—who won't force him into rehab. And that despite seeing him at his worst and most humiliated, she still desires him.

He is deep into this delusion which continues into the next day (and into "Both Sides Now"), when he goes back to work feeling fine, and is anything but. House's vision of Amber has vanished, replaced by his deluded memory of his night with Cuddy.

But then reality hits. Hard. Fact counters House's distorted reality and his entire world implodes. If House has had nothing else, he has always had his rational mind; his keen focus on reality. And as the foundation of his whole being is ripped away, Cuddy watches, stunned. "Are you alright?" she asks, concerned as House, withdrawn into himself, replays the events of the past 24 hours. "No," he finally confesses. "I'm not alright." House's terrified expression and tormented eyes suggest a depth of despair that must only hint at the turmoil boiling within. It's an extraordinary moment for the series and actor Hugh Laurie, who conveys in body language and in that simply-conveyed sentence, an entire year of anguish. We didn't see it coming (well, unless you were spoiled). But, in House's case, it was almost inevitable.

Did you see it coming? What clues did you see along the way (now that you've all had a chance to take another look at the season with 20/20 hindsight)? Let me know in the comments space below.

Much more to come during this summer hiatus: an Emmy discussion, a few "revisited" reviews, flashing back to seasons past, and a few (hopefully very exciting) surprises. So, please stay tuned.

About Barbara Barnett

Barbara Barnett is Publisher/Executive Editor of Blogcritics, (blogcritics.org). Her Bram Stoker Award-nominated novel, called "Anne Rice meets Michael Crichton," The Apothecary's Curse The Apothecary's Curse is now out from Pyr, an imprint of Prometheus Books.
Her book on the TV series House, M.D., Chasing Zebras is a quintessential guide to the themes, characters and episodes of the hit show. Barnett is an accomplished speaker, an annual favorite at MENSA's HalloWEEM convention, where she has spoken to standing room crowds on subjects as diverse as "The Byronic Hero in Pop Culture," "The Many Faces of Sherlock Holmes," "The Hidden History of Science Fiction," and "Our Passion for Disaster (Movies)."